Provider Demographics
NPI:1184640815
Name:BURKE, DENISE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 GOLF VIEW DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-9654
Mailing Address - Country:US
Mailing Address - Phone:541-779-4575
Mailing Address - Fax:
Practice Address - Street 1:749 GOLF VIEW DR
Practice Address - Street 2:SUITE A
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-9654
Practice Address - Country:US
Practice Address - Phone:541-779-4575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 17669207N00000X
ORMD17669207NS0135X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR73486Medicaid
ORR0000BLCGBMedicare ID - Type Unspecified
OR73486Medicaid